77-304 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 ................ ........................................ Permit No.7 �d (Complete In Triplicate) 1.: - --•.._..•--•--...---••................................... This Permit Expires 1 Year from Date Issued Date Issued _...-6.1:: r/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and-install the work herein described. This application is made in compliance with County Ordinance Na. 5.49 and existing Rules and Regulations: 108 ADDRESS/LOCATI N --I�� • -//P/. Lz ' a�•O—/ . l SUS TRACT ............. Owner's Name ......_ C:_ .i ----------------------------------- .Phone �Pla/:7..e.6,F__. AddressC ............ ............. ............ Contractor's Name �jl ...s . .._ .__ Wr._...64 _c........License #1.1_7�01 . Phone Installation will serve: Residence❑Apartment House Commercia I flTraller Court , Motel ❑Other ` Number of living units:............ Number of bedrooms .......:•.__Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name ........... ............................................ ....... ............................................Private 1� Character of soil to a depth of 3 feet: Sand Silt p '❑ ❑ - .Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ Hardpan Q Adob� Fill Material ....: .._ If es a ........I...... ............ ' yes,type , (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse. side.) NEW INSTALLATION: (No septictankor seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT € ] SEPTIC TANK[ } Size--------•---•-------_ .............:.......... Liquid Depth ........................... r ___-R Capacity ----------- Type Material...................... No. Compartments ...................... Distance to nearest: Well ........................ _.______._Foundation -........._..._ Prop, Line __..__.. -� LEACHING LINE [ ] No. of Lines .._._._.-_------------ Length of each line--.......................... Total Length ..........................1. � Sox .. _..._::. Type filter Material - ----------- ------Depth-�Filter'Moterlof 'D' t ...._...___.----� . I - . Distance to nearest: Well ........................ Foundation ----- ........ ; ._..:.--------. Property Line ........................ SEEPAGE PIT [ ) Depth .... ........ Diameter ................ Number ............................ Rock titled Yes ❑ No �❑ Water Table Depth ....... ..................................Rock Size ................................ Distance to nearest: Well ........................................Foundation ._.___....�—.—.'—Prop.Prop. Line ------•-_-_..-•---- C REPAIR/ADDITION(Prev. Sanitation Permit# ----------- ...------- ---------------_ Date _..._...__.____ .................. (� , I Septic Tank (Specify Requirements. _.,......•.................................._....,..._..--------------......-----------------............---......------------...__...._....._ Disposal Field (Specify Requirements) � .--------�•---tl-...... ,f�.�•�-�--�`------ � ��.. W- --..-- / 1/YG---••- ,L e44 ,�//V k. -•---------- --------------------------------- •---- - - .------- 1 -------• --------------------•--•------------------ --------...-----------------•-------••---------- -----•..._.......-•-----•-----•-------------------...__...- •---..------........... ' (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, acrd Rules and Regulations of the San Joaquin Local Health,District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of_the work for which this permit is Issued, l shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------- -- •--•------- Owner BY `---- ---- Title C✓cY � ev-/G_-:,......... -- . (if other than a r) FOR DEPARTMENT USE ONLY Z - APPLICATION ACCEPTED BY _. - -------•- DAVE .._,,.,..... _.._ .. ..,_.�_�.....- ---•-•--•-•......................•--------- ------ BUILDINGPERMIT ISSUED -------- - ---- -•-•- • -------------------------------- --- ------..... ------- ----- DATE .......................... -------......... ADDITIONAL COMMENTS ---...-•----. " ----------------------------------------•................. ------------------------ --•-- --- --- - ina -- ion b --•-•-•-•-------------------•---._............-----------...---•-.---_.._..-- Final Inspection by: :... - --------------------------••--•--•-•.............._.....------.....----.. .__...-Date ...... ... ._ . `.. ... _ ------------ 13 2� � �• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M